Search Results (723)

This study introduces an integrated lower limb robotic orthosis with near-field electrospinning (NFES) piezoelectric sensors and a fuzzy logic-based gait phase detection system to enhance mobility assistance and rehabilitation. The exoskeleton incorporates embedded pressure sensors within the insoles to capture ground reaction forces (GRFs) in real-time. A fuzzy logic inference system processes these signals, classifying gait phases such as stance, initial contact, mid-stance, and pre-swing. The NFES technique enables the fabrication of highly oriented nanofibers, improving sensor sensitivity and reliability. The system employs a master–slave control framework. A Texas Instruments (TI) TMS320F28069 microcontroller (Texas Instruments, Dallas, TX, USA) processes gait data and transmits actuation commands to motors and harmonic drives at the hip and knee joints. The control strategy follows a three-loop methodology, ensuring stable operation. Experimental validation assesses the system’s accuracy under various conditions, including no-load and loaded scenarios. Results demonstrate that the exoskeleton accurately detects gait phases, achieving a maximum tracking error of 4.23% in an 8-s gait cycle under no-load conditions and 4.34% when tested with a 68 kg user. Faster motion cycles introduce a maximum error of 6.79% for a 3-s gait cycle, confirming the system’s adaptability to dynamic walking conditions. These findings highlight the effectiveness of the developed exoskeleton in interpreting human motion intentions, positioning it as a promising solution for wearable rehabilitation and mobility assistance. Full article

Background: Femoroacetabular Impingement Syndrome (FAIS) is a musculoskeletal disorder characterized by hip pain, reduced range of motion (ROM), and functional impairment, particularly in young and physically active individuals. While surgery is generally not performed in individuals under 18 due to skeletal immaturity, it remains a standard treatment option for adults presenting with persistent symptoms and functional limitations. However, the overall effectiveness of physiotherapy-based interventions remains unclear. This review aimed to evaluate the effectiveness of conservative rehabilitation strategies for FAIS, assessing their impact on pain management, functional improvement, and quality-of-life outcomes, rather than directly comparing them to surgical interventions. Methods: This scoping review was conducted following the Joanna Briggs Institute (JBI) framework and PRISMA-ScR guidelines. A systematic literature search was performed in PubMed, Cochrane CENTRAL, Scopus, PEDro, and Web of Science. Studies were included if they examined conservative rehabilitation for FAIS, assessing outcomes such as pain reduction, functional improvement, range of motion (ROM), muscle strength, and quality of life. Data were extracted and synthesized narratively. Results: Both conservative rehabilitation and surgical intervention resulted in significant improvements in pain, function, and quality of life. Exercise-based physiotherapy, particularly programs incorporating core stability, progressive strengthening, and neuromuscular training, demonstrated positive outcomes. Surgery provided faster pain relief, ROM improvements, and earlier functional gains, particularly in activities requiring hip flexion. Given the variability in outcome measures, including pain, function, and quality of life, the interpretation of results must consider differences in treatment protocols across studies. Conclusions: Conservative rehabilitation should be considered a first-line treatment for Femoroacetabular Impingement Syndrome (FAIS), as it provides significant improvements in pain relief, function, and quality of life while mitigating the risks associated with surgery. Exercise-based physiotherapy, particularly programs incorporating core stabilization, progressive strengthening, and neuromuscular training, has demonstrated positive clinical outcomes. Although surgery may offer faster symptom relief and greater short-term functional gains, long-term differences between surgical and conservative management appear minimal in selected patient populations. Structured physiotherapy interventions should be prioritized before surgical consideration, except in cases where symptoms persist despite adequate rehabilitation. Future research should aim to establish standardized rehabilitation protocols, define optimal intervention parameters, and identify patient subgroups most likely to benefit from conservative management. Additionally, longitudinal studies with larger sample sizes are needed to clarify the long-term effects of non-surgical treatments on joint health and functional outcomes. Full article

Background: The objective of this study was to compare the outcomes between patients undergoing mechanically aligned conventional total knee arthroplasty (MA-CTKA) and functionally aligned robotic-arm-assisted TKA (FA-RTKA). Methods: We reviewed a prospectively collected database of consecutive patients who underwent primary total knee arthroplasty (TKA) for knee osteoarthritis between June 2022 and May 2023. Patients were divided into two groups—MA-CTKA (n = 50) and FA-RTKA (n = 50)—based on the introduction of a robotic-arm-assisted system during the study period. The hip–knee–ankle (HKA) angle, joint line orientation angle (JLOA) relative to the floor, and weight-bearing line (WBL) ratio were evaluated using full-length standing hip-to-calcaneus radiographs to compare the conventional mechanical axis (MA) and the ground mechanical axis (GA) passing through the knee joint between the groups. Clinical outcomes were also compared between the two groups. Results: There were no significant differences in the postoperative HKA angle between the groups, due to discrepancies in the targeted alignment strategies (FA-RTKA: 2.0° vs. MA-CTKA: 0.5°; p = 0.001). The postoperative JLOA in the FA-RTKA group was more parallel to the floor, whereas the MA-CTKA group showed a downward angulation toward the lateral side (0.6° vs. −2.7°; p < 0.001). In the FA-RTKA group, the GA passed through a neutral position when accounting for the calcaneus, while the MA-CTKA group showed a more lateral GA position (48.8% vs. 53.8%; p = 0.001). No significant differences in clinical outcomes were shown between the FA-RTKA and MA-CTKA groups, with the FA-RTKA group demonstrating higher Forgotten Joint Scores and a greater range of motion (all p < 0.05). Conclusions: Functionally aligned TKA demonstrated improved joint line parallelism to the floor and more neutral weight-bearing alignment in the GA compared to mechanically aligned TKA. These findings indicate a more balanced load distribution across the knee, which may contribute to the superior clinical outcomes observed in the functionally aligned group. Full article

Background/Objectives: Few studies report on hip rotation after total hip arthroplasty (THA); however, details of the factors affecting the hip rotation angle are unknown. We aimed to investigate the factors related to hip rotation after THA. Methods: This study included 124 consecutive patients who underwent THA. We retrospectively analyzed the correlation between changes in the rotation angle of the femur relative to the pelvis, global femoral offset, and femoral version and leg lengthening. Moreover, we performed a multivariate regression analysis of these parameters to calculate the efficacy of the change in the rotation angle of the femur relative to the pelvis. Results: Leg lengthening and femoral version change were negatively correlated, whereas change in global femoral offset was positively correlated with leg lengthening, with correlation coefficients of 0.376, 0354, and 0.334, respectively. Regarding the multiple regression analysis, only leg lengthening was correlated with the change in rotation angle of the femur relative to the pelvis, with a coefficient of −0.336. Conclusions: The change in the rotation angle of the femur relative to the pelvis is only associated with leg lengthening in multivariate analysis. In actual planning, in cases where the hip is internally rotated, it may be better not to excessively increase leg length, decrease anterior stem anteversion, or increase global femoral offset. Thus, physicians should avoid large leg lengthening for patients with highly external rotation in their hip joint as it may lead to increased internal rotation of the hip, consequently resulting in relative malpositioning and subsequent implant impingement and/or dislocation following THA. Full article

Background: Greater Trochanteric Pain Syndrome (GTPS) is a frequent clinical condition characterized by acute or chronic pain in the lateral region of the hip. This condition is primarily due to gluteus minimus and medius tendinopathy. Swine-derived type I collagen has shown a positive effect on tenocytes through in vitro studies and on tendinopathies in clinical studies. This pilot study aims to evaluate the clinical effects of swine-derived type I collagen injections on pain, hip function, and strength in GTPS patients. Methods: The study group was treated with three ultrasound-guided swine-derived type I collagen injections once a week for three consecutive weeks. The primary endpoint was pain reduction of at least 3 points on the Numeric Rating Scale (NRS) at ten weeks. Secondary endpoints were NRS average reduction at rest and palpation, modified Harris Hip Score (mHHS), abductor strength, and magnetic resonance imaging (MRI) improvement at six months. Results: 52 patients were screened, 47 enrolled, and 43 completed the study. The primary endpoint was reached by 60.5% of the patients. All secondary endpoints were also reached with statistical significance. Neither early nor late adverse effects were found. Conclusions: In this pilot study, ultrasound-guided peritrochanteric swine-derived type I collagen injections are safe and effective for most patients with GTPS included in the study. Further and more extensive confirmatory investigation studies with a longer follow-up are needed to confirm this pilot study’s results and the clinical benefit’s persistence. Full article

This cross-sectional laboratory-based study investigates the stress characteristics of the anterior cruciate ligament (ACL) during side-cutting using a knee finite element (FE) model and identifies biomechanical factors influencing ACL stress. Kinematics and ground reaction forces (GRF) were collected from eight participants (age: 30.3 ± 5.3 years; BMI: 25.6 ± 2.4 kg/m²; time since surgery: 12.8 ± 1.2 months) one year post–ACL reconstruction during side-cutting tasks. A knee FE model incorporating time-varying knee angles, knee forces, and femoral translation was developed to simulate the knee biomechanics. The relationships between ACL stress and lower limb biomechanics were analyzed. The results indicated the highest stress concentrations at the femoral attachment during the early landing phase. Posterior femoral displacement relative to the tibia was significantly correlated with peak ACL equivalent stress (r = 0.89, p = 0.003) and peak ACL shear stress (r = 0.82, p = 0.023). Peak ACL equivalent stress also showed positive correlations with posterior GRF (r = 0.77, p = 0.025) and knee extension moments (r = 0.71, p = 0.049). In contrast, peak ACL shear stress exhibited a significant negative correlation with hip extension moment (r = −0.80, p = 0.032). This study identified key biomechanical factors affecting ACL stress, highlighting the roles of femoral displacement, knee extension moments, and ground reaction forces, while demonstrating a negative relationship with hip extension moments. Full article

The primary aim of this study was to evaluate the spatial and temporal variation in human exposure to electromagnetic fields across different frequency bands within an urban area identified as the commercial zone of a medium-sized city. Central to this investigation was the use of an exposimeter, strategically positioned on the back of the operator and secured to the hip area via a belt, to ensure comprehensive and accurate field measurements. An initial analysis was conducted to determine the shielding coefficients of the human body, allowing for precise corrections of the electric field values used in the spatial assessment. To map power density across the study area for each frequency, kriging interpolation was applied. Furthermore, temporal variations in exposure levels were analyzed at three distinct times of day—morning business hours, afternoon business hours, and non-business hours—using robust statistical methods. The study’s innovative approach lies in the integration of GIS technology to uncover and visualize temporal patterns in exposure, particularly during periods of higher pedestrian density. This integration facilitated both the detection of temporal variations and the spatial representation of these changes, enabling rapid identification and assessment of exposure hotspots. Full article

Background/Objectives: Tendinopathy is the preferred term to describe various tendon pathologies, including paratendinitis, tendinitis, and tendinosis, in the absence of histopathological evidence in biopsy specimens. The management of tendinopathies is challenging; rest, physiotherapy (such as eccentric training), injections, shock waves, orthotics, medical therapy, and surgery are the main therapeutic options offered to the patient. The conservative treatment of tendinopathies is still difficult, but several options have been proposed, including the use of anti-inflammatory molecules. In this retrospective study, we aimed to assess the efficacy of a conservative approach in improving pain and functional improvement in hip bursitis (HB) and biceps tendinitis (BT) patients. Methods: A series of data concerning the application of Polynucleotides High Purification Technology (PN HPT^TM) in 47 patients with BT and HB was analyzed. All patients received three bi-weekly injections of PN HPT^TM (T0–T2). Follow-up visits were performed at T3 (8 weeks from T2) and T4 (24 weeks from T2). Both the visual analog scale (VAS) for pain assessment and functional impairment (FI) scores were processed in the form of anonymized series for clinical improvement evaluations. Results: Statistically significant differences (p < 0.001) in pain reduction (−85%) and functional improvement (+86%) were found at the end of treatment. The levels of patient satisfaction (PS) and Clinical Global Improvement—Impression (CGI-I) were equal to 93% and 98%, respectively. According to the analyses, other patient data (e.g., gender, age, and BMI) did not appear to influence the positive treatment outcomes. Conclusions: The application of High Purification Technology (PN HPT^TM) was shown to improve both pain and functional deterioration in patients with tendonitis in a similar manner to other conservative treatments. These retrospective analyses may open up new avenues for the implementation of conservative approaches in patients with tendinitis. Full article

Femoroacetabular impingement syndrome (FAIS) is characterized by hip pain and restricted range of motion (ROM), typically due to structural conflict between the femoral neck and the acetabulum. This study aimed to quantify active ROM limitations in FAIS patients, comparing them with healthy controls to establish normative values, particularly in non-conflicting directions. Methods: A total of 53 FAIS patients scheduled for hip arthroscopy were compared to 49 healthy matched controls. Active ROM was assessed using inertial measurement unit (IMU) sensors, with measurements taken in standing and prone positions. Outcomes included flexion, external rotation, internal rotation, and total rotation ROM, alongside demographic and radiographic data. Gender-based ROM differences were also analyzed. Results: FAIS patients demonstrated significant reductions in flexion, internal rotation, and total rotation ROM in the involved hip, with large effect sizes, while external rotation remained unaffected. ROM in the uninvolved hip was also lower than in controls but showed increased external rotation. Gender differences were observed, with females exhibiting significantly higher internal rotation and, in healthy controls, greater total rotation than males. Conclusions: FAIS patients have significant active ROM restrictions in non-conflicting directions, suggesting broader joint limitations potentially tied to early hip osteoarthritis or capsular and musculoskeletal adaptations. Gender differences highlight the importance of individualized ROM assessment. This study introduces IMU-based ROM evaluation as a promising tool for diagnosing and monitoring FAIS, providing insights into functional impairments that can be used to guide targeted interventions. Full article

Background/Objectives: Osteoporosis is a global problem that will increase as the population increases and ages, requiring prevention, early detection, and appropriate treatment. An increasing loss in bone mineral density (BMD) is the hallmark of osteoporosis, leading to an increased risk for insufficiency fractures. We aimed to investigate and analyze the applicability of native lumbar spine computed tomography (CT) scans for the evaluation of bone density compared with standard bone density measurements with quantitative computed tomography (QCT) and computed tomography X-ray absorptiometry of the hip (CTXA). Methods: Patients who were referred to our institution for diagnostic investigations and underwent CT imaging of the lumbar spine, as well as standard osteoporosis assessments including QCT and CTXA, were included in the study, resulting in a total of 240 patients (mean age: 65.9 years, range: 24–91). An ANOVA test was used to compare patient groups without a fracture, with one fracture, with more than one fracture, and with additional sacral fractures. An ROC analysis was performed to assess the predictive power of fracture risk estimation considering HU, QCT, and CTXA values. Results: At least one fracture was detected in 42.9% of these patients. For the lumbar spine, the median HU was 89.9 (range 67.9–126.9) and the median BMD was 73.7 (range 57.1–104.2) mg/cm³. With a correlation coefficient of 0.98 (p < 0.001), the HU values obtained from native lumbar CT scans can be calculated using the following formula: BMDspine = 0.84 + (0.81 × HU). With HU values < 80 and a BMD of the lumbar spine < 66 mg/cm³, a significantly increased number of osteoporotic vertebral fractures were found in the mid-thoracic, thoracolumbar, and sacral regions with an effect size of 0.89. In 32 patients (13.3%), additional sacral fractures were found; these patients showed the lowest density values with a median HU value of 31.8 (12.7–58.2). An ROC analysis of HU revealed a 93% sensitivity for the coincidence of a vertebral fracture. There was no significant difference compared with the AUC of QCT (p = 0.395) for concomitant vertebral body fractures. CTXA values also allowed for risk assessment but showed a significantly lower AUC. We found a negative correlation of BMD with age and a positive correlation of BMD with body mass index. Conclusions: Cancellous density measurements in HU values can be effectively converted into quantitative BMD values in mg/cm³, enabling a reliable assessment of osteoporosis severity and fracture risk prediction. Further quantitative density evaluation of the hip does not add value to fracture risk assessment for the axial skeleton. Based on this study’s findings, using HU values in native CT of the lumbar spine alone offers a viable, opportunistic approach towards fracture risk evaluation of the spine. Full article

Lower extremity misalignments increase the risk of chronic overload and acute injuries during sports and daily activities. Medial positioning of the knee and foot in the frontal plane is one of the key biomechanical risk factors associated with lower extremity injuries and pain. Different exercise interventions have been implemented to counteract misalignments. However, most studies have been conducted on clinical populations. Therefore, in this review, we aimed to assess the preventive effects of exercise interventions on frontal plane knee and foot posture in healthy individuals. Electronic databases (PubMed, Web of Science, PEDro) were systematically searched for original articles published between 2008 and 2024. This review included clinical trials on healthy adults (18–45 years) with or without lower extremity biomechanical misalignments, examining the effects of exercise interventions alone on knee and foot frontal plane biomechanics. Eligible studies reported at least one relevant frontal plane foot and knee biomechanical measure, such as knee valgus/abduction, medial knee displacement, foot pronation/eversion, or navicular drop. Studies involving non-exercise interventions, single-session protocols, and participants with neurological or spinal disorders, pain, or injury were excluded. A total of 35 articles with 1095 participants were included in this review. A total of 20 studies included individuals without a biomechanical misalignment, and 15 studies focused on individuals with a biomechanical misalignment. Mean values, standard deviations, and p-values were extracted from the included studies. Effect sizes and confidence intervals were then calculated to provide a quantitative presentation of the data. In conclusion, in healthy individuals without biomechanical misalignment, technique training and core muscles strengthening were most effective for improving knee valgus. Hip, core, and foot muscle strengthening reduced foot pronation in those with pronated feet, while short foot exercises improved foot positioning in individuals with flat feet. Combining lower extremity strengthening with knee position control training may reduce knee valgus in individuals with increased knee valgus. Full article

Jump rope is a widely applied basic training technique in various sports, yet it is understudied biomechanically. This study investigates the impact of cycle-tempo-induced motor control changes in elite jump rope athletes, addressing the biomechanical gap of cyclic skill control. The hypothesis posited two accelerations per jump cycle—one in front of and one behind the body—and anticipated that increased cycle frequency would alter the distribution of acceleration time within a cycle. Using 3D motion capture technology, 12 young elite jump rope athletes were analyzed at 100, 140, and 180 revolutions per minute (rpm). The kinematic parameters obtained confirmed the presence of two distinct accelerations per cycle. As tempo increased, the percentage of rear acceleration time increased from 9.58% at 100 rpm to 17.42% at 180 rpm, while front acceleration time decreased from 39.03% at 100 rpm to 31.40% at 180 rpm, along with peak velocities increasing from 12.94 m/s at 100 rpm to 22.74 m/s at 180 rpm significantly (p < 0.01). Rope trajectory analysis indicated a consistent movement pattern across tempos, primarily in the sagittal plane. Variations in skill control revealed shorter contact phases, decreasing from 61.53% at 100 rpm to 48.25% at 180 rpm, as well as a reduced vertical range of motion for the center of gravity (from 0.15 body height at 100 rpm to 0.06 body height at 180 rpm) and feet (from 0.05 body height at 100 rpm to 0.03 body height at 180 rpm) (p < 0.05). Significant reductions were also observed in the flexion/extension range of motion for the hip (from 22.31° at 100 rpm to 3.47° at 180 rpm), knee (from 49.31° at 100 rpm to 9.35° at 180 rpm), and ankle (from 52.99° at 100 rpm to 21.41° at 180 rpm) (p < 0.01). These findings enhance the understanding of motor control adaptations to different tempos and have practical implications for developing coaching programs aimed at optimizing performance, stability, and efficiency in jump rope training. Full article

Background/Objectives: This study aimed to investigate the effect of upper extremity activity capacity and hand grip strength on early post-operative ambulation in geriatric patients undergoing hip arthroplasty for hip fracture. Methods: This study included patients over 70 years of age who underwent cementless bipolar hemiarthroplasty for geriatric femoral neck fracture to form a homogeneous cohort. This prospective study was terminated when the number of patients reached 102 after power analysis. Demographic data, cumulative ambulation scores (CASs), quick disabilities of the arm, shoulder, and hand (QDASH) scores, and hand grip strength (HGS) were recorded both pre-operatively and post-operatively (3rd and 30th days). The presence of a linear relationship between the numerical and ordinal variables was analyzed using correlation analysis. Results: The mean age of the patients was 78.8 years (range: 70–93 years). There was a positive correlation between the HGS and CAS (r = 0.717, p < 0.05). A negative correlation was found between HGS, age (r = −0.529, p < 0.05), and QDASH scores (r = −0.408, p < 0.05). There was a negative correlation between the QDASH score, HGS, and CAS, and a positive correlation between the QDASH score and age (p < 0.05). Conclusions: This study showed a direct relationship between post-operative ambulation capacity, upper extremity activity capacity, and hand grip strength in geriatric hip fractures. While older age negatively affects this capacity, upper extremity activity capacity and hand grip strength positively affect it. Full article

(1) Background: Commonly used anthropometric indices have limitations that discriminate their relevance. The subject of this research was to evaluate the health risks associated with body composition using the new weight-adjusted waist index (WWI). (2) Materials and Methods: The research group consisted of two hundred and thirty-nine Caucasian women. Body composition was analyzed by the MF-BIA method using InBody 970. The WWI was calculated as waist circumference divided by the square root of weight. Biochemical parameters (lipid profile, glucose, hs-CRP and uric acid) were analyzed using a Biolis 24i Premium biochemical analyser. One-factor variance analysis, a post-hoc test, Pearson correlation analysis and WWI quartiles were used for the statistical evaluation. (3) Results: The results showed significant differences between WWI quartiles. Compared to the lowest quartile, participants in the highest quartile groups had the highest values of body weight (58.49 vs. 87.17 kg; p < 0.001), waist circumference (WC) (76.47 vs. 109.45 cm; p < 0.001), body mass index (BMI) (20.65 vs. 32.06 kg/m²; p < 0.001), waist-to-hip ratio (WHR) (0.84 vs. 1.03; p < 0.001), waist-to-height ratio (WHtR) (0.46 vs. 0.66; p < 0.001), fat-free mass (FFM) (44.97 vs. 49.12 kg; p < 0.001), fat mass (FM) (13.52 vs. 38.05 kg; p < 0.001) and visceral fat area (VFA) (56.94 vs. 150.62 cm²; p < 0.001), confirming a higher risk of obesity. The women in the highest quartile had significantly higher values of total cholesterol (TC), triglycerides (TG), glucose (GLU), uric acid (UA), high-sensitivity C-reactive protein (hs-CRP) and systolic and diastolic blood pressure (BP). The correlations showed a strong positive relationship of the WWI with WC (r = 0.924), VFA (r = 0.907) and FM (r = 0.901) and a strong negative relationship with %FFM (r = −0.9) and %SMM (skeletal muscle mass) (r = −0.887). The correlation analysis also confirmed a strong positive association with WHR (r = 0.964), WHtR (r = 0.944), FMI (r = 0.902) and BMI (r = 0.863). (4) Conclusions: Our results confirmed that the WWI is a useful tool for assessing fat and muscle components, as well as for assessing health risks. Full article

This study explores the effectiveness of the Movement System Impairment (MSI) model compared to traditional physiotherapy for treating knee pain. Fifty patients with unilateral knee pain participated, with their femur, tibia, and knee alignment assessed in nine functional positions. Evaluations included the Tegner Activity Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), muscle power, extensibility, and pain levels. Patients were randomly assigned to either the MSI treatment group, which focused on identifying and correcting faulty movements, or a routine physiotherapy group that received general strengthening and stretching exercises. Results indicated that both treatment approaches improved muscle power in hip abductors and lateral rotators, as well as scores on the Tegner Activity Scale and the KOOS. Notably, the MSI group demonstrated greater improvements in the muscle power of the hip lateral rotators and knee extensors and a significant reduction in knee pain during walking compared to the routine group (p = 0.005). In conclusion, both treatments enhanced pain, function, and muscle strength, while the MSI model significantly reduced knee pain in walking and improved hip and knee muscle power compared to routine physiotherapy. Full article